Nurses' and physicians' experience of a new algorithm for tapering analgosedation in the paediatric intensive care unit: A focus-group investigation

Abstract

Aim/objective: Iatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new "algorithm for tapering analgosedation" METHODS: We used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study.

Findings: Three focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: "Caring for a child in withdrawal", "Advantages of the algorithm", and "Challenges of the algorithm". The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments.

Conclusion: Nurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education.

Keywords: Algorithm; Focus group; Iatrogenic; Implementation; Paediatric intensive care unit; Qualitative research; Withdrawal syndrome.